Evidence is emerging that beliefs about voices are influenced by broader schematic beliefs about the self and others. Similarly, studies indicate that the relationship an individual has with their voice may mirror wider patterns of relating observed in social relationships, which may be influenced by schematic beliefs.

This study examined associations between beliefs about voices and self and other schemas. Furthermore, associations between schemas and the perceived relationship between the hearer and their predominant voice were explored.

Forty-four voice-hearing participants were recruited across mental health services. Participants completed self-report measures of beliefs about voices, schema functioning, and relating between the hearer and their voice. Dimensions of voice experience, such as frequency and content, were assessed using a clinician-rated scale.

Beliefs about voices correlated with negative voice content and schemas. After controlling for negative voice content, schemas were estimated to predict between 1 and 17% of the variance in the six measured beliefs about voices; three of the associations reached statistical significance. Negative-self schema were the strongest predictors of beliefs about voices, whilst positive-self also showed potential relationships. Schemas also correlated with dimensions of relating between the hearer and their voice.

In line with previous research, this study provides evidence that schemas, particularly self-schema, may be important in the development of beliefs about voices. This study offers preliminary findings to suggest that schemas are also associated with the perceived relationship between the hearer and their voice.

The Salkovskis (1999) model of obsessive compulsive disorder (OCD), which emphasizes the role of inflated responsibility, has proven highly influential in both the understanding and treatment of OCD.

This study aimed to empirically test several core processes of this model.

The individual components of the model were measured using multiple indicators in a sample of undergraduate students (n = 170), and confirmatory factor analyses were used to ascertain the most reliable, valid and theoretically consistent latent variables. Structural equation modelling was used to test proposed relations between latent constructs in the model.

The inflated responsibility model was a good fit for the data in the present sample. As predicted by the model, misinterpretations of intrusive thoughts as indicating personal responsibility fully mediated the relationships between responsibility beliefs and counterproductive safety strategies, neutralizing actions and mood changes.

The Salkovksis (1999) inflated responsibility model of OCD is empirically supported in the present sample of undergraduate students, lending support to the proposed mechanisms in the model and supporting prior evidence.

Cognitive models of post-traumatic psychological adjustment have implicated both self-concept and self-appraisals in post-traumatic stress disorder (PTSD). Two studies investigated the relationship between self-concept and trauma-related self-appraisals, and whether culture influenced this relationship.

In Study 1, a student sample (Asian n = 41, British n = 34) who self-identified as having been through a trauma or extremely stressful event completed measures of self-concept, trauma-related self-appraisals and trauma-related distress. Study 2 extended this by asking Asian (n = 47) and British (n = 48) trauma survivors with and without PTSD to complete the same self measures as those administered in Study 1.

Study 1 found that overall for the British group, disruptions in self-concept (i.e. self-discrepancies and trauma-themed self-concept) correlated significantly with negative self, world and self-blame appraisals and depression. However, the same was not found in the Asian group. Study 2 found that pan-culturally those with PTSD had greater self-discrepancies and trauma-defined self-concept than those without PTSD. Additionally, pan-culturally, trauma-defined self-concept correlated significantly with negative self appraisals and depression; ideal self-discrepancies correlated significantly with negative self-appraisals across cultures and depression for the British group; while ought self-discrepancies correlated significantly with negative world appraisals for the Asian group and negative self and self-blame appraisals for the British. Lastly, negative self, world and self-blame appraisals correlated with symptoms of depression.

Taken together, the findings relay the important associations between appraisals, self-concept and post-traumatic psychological adjustment.

Imagery rescripting (IR) for early aversive memories in patients with social anxiety disorder (SAD) has shown promising results, but no study has investigated the reactions and perspectives of patients who received IR.

This study aimed to gain understanding of patients’ experiences/perspectives on IR as an adjunct to cognitive behavioural therapy (CBT) for SAD.

Twenty-five individuals with SAD received one or two sessions of IR over 16 CBT sessions. Contents of recurrent images and linked memories were identified during IR. Outcome measures included social anxiety, image and memory distress and vividness, and encapsulated belief. Patients completed a questionnaire about their perspectives of IR after the session. Thematic analysis was used to analyse the qualitative data.

IR resulted in significant within-session improvement in most outcome measures. Linked memories to negative recurrent images in social situations were categorized into nine groups. Common memories were ‘Being criticized by others’, ‘Being made fun of’, ‘Failing or not doing something well’ and ‘Being left out in a group’. Most patients (82%) experienced IR as impressive, and more than half of patients (59%) found IR effective. Themes of reasons of impressiveness and effectiveness were categorized as ‘Results of IR session’ and ‘Processes of IR session’. The theme ‘Results of IR session’ included six subthemes, and the theme ‘Processes of the IR session’ included five subthemes.

Regarding patients’ perspectives, although they may experience negative emotions in the process of an IR session, our results suggest that many patients with SAD found IR sessions effective.

The relevance of schema theory to psychopathology, in particular personality disorder, in younger adults is established. Investigations into the relevance of schema theory to older adults, however, is highly limited.

To consider the relationship of schema modes to psychopathology in older adults and establish whether maladaptive schema modes are associated with unmet needs and that this relationship is mediated by the healthy adult mode of responding in this population.

One hundred and four older adults were recruited from an established database. Participants completed questionnaires assessing psychopathology, schema modes (YAMI: Young-Atkinson Mode Inventory) and basic psychological needs (BPNS: Basic Psychological Needs Scale – autonomy, competence and relatedness). Ninety-four responses were included after applying exclusion criteria.

The healthy adult schema mode was found to be associated with reduced psychopathology, and maladaptive child modes (angry and vulnerable child) to increased psychopathology. The healthy adult schema mode mediated the relationship between maladaptive child modes and needs satisfaction.

As predicted by schema theory, the presence of one of the maladaptive child modes makes it difficult for an older individual to have their needs met, but the presence of healthy adult mode works to support this process.

Accurate psychometrics benefit from assessing given constructs within specifically defined contexts. The assessment of context-specific irrational beliefs as put forth in rational emotive behaviour therapy (REBT), under the three basic psychological needs described in self-determination theory (SDT), represents a new path for research. Under the umbrella of ‘positive psychology’, a new scale for adolescents combining REBT and SDT is the first step towards conceptualizing irrational beliefs within the three basic psychological needs. The integration of REBT and SDT would provide a more fully integrated view of adolescent mental health, and as such could provide a more cost-effective approach for preventing cognitive, emotive and behavioural disturbances in young people.

The main aim of this paper is to outline the development and validation of the Rational Emotive Self Determination Scale for Adolescents (RESD-A), which measures irrational beliefs about the three basic psychological needs (autonomy, competence and relatedness).

To achieve this main study aim, we report the results of four studies that test the factor structure, internal consistency, construct, predictive validity, and test–re-test reliability of the 51-item RESD-A, within samples of Turkish adolescents.

Data analyses confirmed the theoretical expectations and yielded promising results for the validity and reliability of the RESD-A.

The results suggest that assessment of irrational beliefs in the context of autonomy, competence and relatedness is possible and valuable for the treatment of adolescents.

According to cognitive behavioural theory, cognitive factors (i.e. underlying general dysfunctional beliefs and (situation) specific illness beliefs) are theorized to lead to outcomes like anxiety and depression. In clinical practice, general dysfunctional beliefs are generally not tackled directly in short-term-therapy.

The goal of the present study was to investigate the associations of general versus specific illness beliefs on anxiety and depressive symptoms and psychiatric disorders among a subgroup of patients with inflammatory bowel disease (IBD) with poor mental quality of life (QoL).

This study concerns cross-sectional data, collected at baseline from a randomized clinical trial. One hundred and eighteen patients, recruited at four Dutch hospitals, with poor QoL (score ≤23 on the mental health subscale of the Short-Form 36-item Health-Survey; SF-36) were included. General dysfunctional beliefs were measured by the Dysfunctional Attitude Scale (DAS), specific illness beliefs by the Illness Perceptions Questionnaire-Revised (IPQ-R), anxiety and depressive symptoms by the Hospital Anxiety and Depression Scale (HADS), and psychiatric disorders by the Structured Clinical Interview for DSM-IV Axis-I Disorders (SCID-I).

Univariate analyses showed associations between the level of anxiety and/or depression and general dysfunctional beliefs and four specific illness beliefs (consequences, personal control, emotional representations and treatment control). Among patients with IBD with psychiatric disorders, only the DAS was significantly associated with anxiety and depression (DAS added to IPQ-R and IPQ-R added to DAS).

Psychological interventions may have to target general dysfunctional beliefs of patients with IBD with co-morbid psychiatric disorders to be effective. These patients with IBD are especially in need of psychological treatment.

Patients with eating disorders (ED) or obesity show difficulties in tasks assessing decision-making, set-shifting abilities and central coherence.

The aim of this study was to explore executive functions in eating and weight-related problems, ranging from restricting types of ED to obesity.

Two hundred and eighty-eight female participants (75 with obesity; 149 with ED: 76 with restrictive eating, 73 with bingeing-purging symptoms; and 64 healthy controls) were administered the Wisconsin Card Sorting Test, the Iowa Gambling Task, and the Group Embedded Figures Test to assess set-shifting, decision-making and central coherence, respectively.

Participants with either obesity or ED performed poorly on tests measuring executive functioning compared with healthy controls, even after controlling for age and intelligence. Both participants with obesity and participants with ED showed a preference for global information processing.

The findings suggest that treatments for obesity and ED would benefit from addressing difficulties in cognitive functioning, in addition to the more evident clinical symptoms related to eating, body weight and shape.

Lowering the cost of assessing clinicians’ competence could promote the scalability of evidence-based treatments such as cognitive behavioral therapy (CBT).

This study examined the concordance between clinicians’, supervisors’ and independent observers’ session-specific ratings of clinician competence in school-based CBT and treatment as usual (TAU). It also investigated the association between clinician competence and supervisory session observation and rater agreement.

Fifty-nine school-based clinicians (90% female, 73% Caucasian) were randomly assigned to implement TAU or modular CBT for youth anxiety. Clinicians rated their confidence after each therapy session (n = 1898), and supervisors rated clinicians’ competence after each supervision session (n = 613). Independent observers rated clinicians’ competence from audio recordings (n = 395).

Patterns of rater discrepancies differed between the TAU and CBT groups. Correlations with independent raters were low across groups. Clinician competence and session observation were associated with higher agreement among TAU, but not CBT, supervisors and clinicians.

These results support the gold standard practice of obtaining independent ratings of adherence and competence in implementation contexts. Further development of measures and/or rater training methods for clinicians and supervisors is needed.

Borderline personality disorder (BPD) usually begins in adolescence and manifests itself in adult life. Early intervention can improve the prognosis or reduce its severity. Nevertheless, there are currently few studies of adolescent patients with severe emotion instability and borderline personality traits.

To evaluate the effectiveness of the Systems Training for Emotional Predictability and Problem Solving (STEPPS) programme in a sample of 21 adolescents (aged 13–17 years) in the Child and Adolescents Mental Health Center of Tarragona in Spain.

We evaluated BPD traits using the Diagnostic Interview for Borderline Disorder-Revised (DIB-R) and the Global Clinical Impression Scale of Illness Severity for TLP (CGI-TLP). We compared pre- and post-treatment scores for the DIB-R, CGI-GI scale, general psychopathology using the Personality Inventory for Adolescents (PAI-A) and impulsivity with the Barratt Impulsivity Scale (BIS-11). The therapeutic objectives were evaluated with the Borderline Estimate Severity over Time (BEST) scale.

There was a statistically significant improvement in the scores for the affective area and in the total score of the DIB-R, a decrease in the percentage of patients who failed to meet criteria for BPD, and an improvement (although not statistically significant) in the scores of the BEST scale throughout the treatment. The results of the CGI-GI scale showed global improvement in almost 72% of patients.

Our study suggests that STEPPS can be an effective treatment to improve BPD symptoms and is very useful in community settings with limited resources in which efficient treatment alternatives must be sought. However, this conclusion must be interpreted with caution, as there is no comparison control group.

Schema therapy is an effective treatment for borderline personality disorder and other complex disorders. Schema therapy is feasible in older adults, and the first empirical support for its effectiveness in later life was provided in older patients with a cluster C personality disorder. The central concept of the schema therapy model is the early maladaptive schema (EMS). Early adaptive schemas (EAS) give rise to adaptive behaviour, and they also emerge during childhood, when core emotional needs are adequately met by primary caregivers.

To examine the concept of EAS and its application in schema therapy with older adults.

Literature review and case example: the role of EAS in schema therapy with older adults is discussed and suggestions for integrating EAS in schema therapy in later life are proposed.

Directing attention in therapy to EAS may help strengthen the healthy adult mode, and it might also help change a negative life review. Working with positive schemas may be an important avenue for re-awakening positive aspects of patients, reinforcing the therapeutic relationship, creating a positive working atmosphere, and also for facilitating the introduction of experiential schema therapy techniques.

This review suggests that positive schemas may be important vehicles of therapeutic change when working with older people. There is a need for validating the Young Positive Schema Questionnaire (YPSQ) in older adults, and for examining whether integrating EAS in schema therapy with older adults indeed has a positive effect on therapy outcome.

Alcohol misuse is common in bipolar disorder and is associated with worse outcomes. A recent study evaluated integrated motivational interviewing and cognitive behavioural therapy for bipolar disorder and alcohol misuse with promising results in terms of the feasibility of delivering the therapy and the acceptability to participants.

Here we present the experiences of the therapists and supervisors from the trial to identify the key challenges in working with this client group and how these might be overcome.

Four therapists and two supervisors participated in a focus group. Topic guides for the group were informed by a summary of challenges and obstacles that each therapist had completed at the end of therapy for each individual client. The audio recording of the focus group was transcribed and data were analysed using thematic analysis.

We identified five themes: addressing alcohol use versus other problems; impact of bipolar disorder on therapy; importance of avoidance and overcoming it; fine balance in relation to shame and normalising use; and ‘talking the talk’ versus ‘walking the walk’.

Findings suggest that clients may be willing to explore motivations for using alcohol even if they are not ready to change their drinking, and they may want help with a range of mental health problems. Emotional and behavioural avoidance may be a key factor in maintaining alcohol use in this client group and therapists should be aware of a possible discrepancy between clients’ intentions to reduce misuse and their actual behaviour.

It is important to understand the factors associated with more severe mood symptoms in bipolar disorder. The integrative cognitive model of bipolar disorder proposes that extreme appraisals of changes to internal states maintain and exacerbate mood symptoms.

The current study aimed to investigate if post-traumatic stress disorder (PTSD) is related to current depressive and manic bipolar symptoms, and whether this relationship is mediated by appraisals of internal state.

Participants with bipolar disorder (n = 82) from a randomized controlled trial of cognitive therapy for bipolar disorder (the TEAMS trial) completed self-reported questionnaires assessing appraisals of internal state, generalized anxiety symptoms, and self-reported and observer-rated depressive and manic symptoms. Clinical interviews assessed PTSD co-morbidity.

Participants with bipolar and co-morbid PTSD (n = 27) had higher depressive symptoms and more conflicting appraisals than those without PTSD. Regression analyses found PTSD to be associated with depressive symptoms but not manic symptoms. Conflicting appraisals were found to be associated only with manic symptoms meaning that the planned mediation analysis could not be completed.

Findings provide partial support for the integrative cognitive model of bipolar disorder and highlight the need for transdiagnostic treatments in bipolar disorder due to the prevalence and impact of trauma and co-morbidity. Working on trauma experiences in therapy may impact on depressive symptoms for those with bipolar disorder and co-morbid PTSD.

Homework assignments are generally viewed as an important factor of cognitive behaviour therapy (CBT).

This study examined whether perfectionists procrastinate homework assignments.

Thirty-eight university students attended two sessions, 7 days apart from each other. After completing perfectionism scales at the first session, they were asked to complete homework tasks from a self-help wellbeing booklet and return the booklet at session 2.

Only maladaptive facets of perfectionism correlated with most of the behavioural measures of procrastination. Moreover, those high in maladaptive perfectionism set and completed fewer planned activities to improve their mood.

These findings suggest that perfectionism may affect how clients set their homework, and perfectionism may interfere with the homework assignments of CBT.

Therapist validation in treatment is theorized to be related to positive outcomes (Linehan, 1993), including keeping patients in therapy longer.

We sought to evaluate the role of therapist validation from both therapists’ and clients’ perspectives as a predictor of drop-out from psychotherapy in three cognitive behavioural training clinics.

Clients in psychotherapy (n = 50; 80% female; 82% Caucasian) and their trainee therapists (n = 22; 68% female; 86% Caucasian) rated validation by the therapist at each of four early sessions of therapy.

After accounting for symptom severity, clients who reported greater therapist validation were less likely to drop out of treatment. Therapist ratings of their own validating behaviours were unrelated to client drop-out. Therapist experience moderated the relation between client-rated validation and drop-out, such that validation was unrelated to drop-out for more experienced therapists.

Assessing and attending to client perceptions of validation by the therapist early in treatment, with brief self-report inventories, can alert therapists to clients at greater risk of drop-out.

Insomnia and depression are clearly interrelated. Several studies showed that treating insomnia with cognitive behavioural therapy positively affects concurrent depressive symptoms. However, it is unclear what treatment component is responsible for the change in depressive symptoms.

To develop the evidence base we employed a case series design in which we administered a single component sleep restriction treatment to individuals with both insomnia and depressive symptoms.

Seven patients were included, of whom six completed the intervention. Patients completed weekly assessments during the 4-week wait period and 6-week treatment phase.

At the post-assessment, two out of six patients showed clinical improvement in depressive symptoms. All six patients showed clinically meaningful improvement at the 3-month follow-up assessment, and two patients had maintained gains at 6-month follow-up.

This case series study shows that, especially at 3-month follow-up, sleep restriction therapy is associated with clinically relevant treatment gains in patients with both insomnia and depressive symptoms.

Metacognition refers to the ability to evaluate and control our cognitive processes. While studies have investigated metacognition in schizophrenia and clinical high risk for psychosis (CHR), less is known about the potential mechanisms which result in metacognitive deficits.

We aimed to investigate whether neurocognitive functions including attention, working memory, verbal learning and executive functions predicted the tendency to focus on one’s thoughts (cognitive self-consciousness) and beliefs in the efficacy of one’s cognitive skills (cognitive confidence).

Participants (130 CHR individuals) were recruited as part of the multi-site PREDICT study. They were assessed using the Metacognitions Questionnaire (MCQ) as well as measures of executive function (WCST), attention (N-Back), working memory (LNS) and verbal learning (AVLT).

Cognitive competence was negatively correlated with N-Back while cognitive self-consciousness was positively correlated with N-Back and LNS. Linear regression analysis with N-Back, AVLT, LNS and WCST as predictors showed that neurocognition significantly predicted cognitive self-consciousness, with N-Back, LNS and WCST as significant predictors. The model accounted for 14% of the variance in cognitive self-consciousness. However, neurocognition did not result in a significant predictive model of cognitive competence.

Neurocognition was associated with an increased focus on one’s thoughts, but it was not associated with higher confidence in one’s cognitive skills. Neurocognition accounted for less than one-sixth of the variance in metacognition, suggesting that interventions that target neurocognition are unlikely to improve metacognitive abilities.

Even in cases with complexity, simple techniques can be useful to target a specific symptom. Intrusive mental images are highly disruptive, drive emotion, and contribute to maintaining psychopathology. Cognitive science suggests that we might target intrusive images using competing tasks.

We describe an imagery competing task technique within cognitive behavioural therapy (CBT) with a patient with bipolar disorder and post-traumatic stress disorder (PTSD) symptoms. The intervention – including Tetris computer game-play – was used (1) to target a specific image within one therapy session, and (2) to manage multiple images in daily life.

A single case (AB) design was used. (1) To target a specific image, the patient brought the image to mind and, after mental rotation instructions and game-play practice, played Tetris for 10 minutes. Outcomes, pre- and post-technique, were: vividness/distress ratings when the image was brought to mind; reported intrusion frequency over a week. (2) To manage multiple images, the patient used the intervention after an intrusive image occurred. Outcomes were weekly measures of: (a) imagery characteristics; (b) symptoms of PTSD, anxiety, depression and mania.

(1) For the target image, there were reductions in vividness (80% to 40%), distress (70% to 0%), and intrusion frequency (daily to twice/week). (2) For multiple images, there were reductions from baseline to follow-up in (a) imagery vividness (38%), realness (66%) and compellingness (23%), and (b) PTSD symptoms (Impact of Events Scale-Revised score 26.33 to 4.83).

This low-intensity intervention aiming to directly target intrusive mental imagery may offer an additional, complementary tool in CBT.

Group psychotherapy for older adults with generalised anxiety disorder is an under-researched area.

This report describes a mixed method evaluation of the acceptability and feasibility of an Overcoming Worry Group.

The Overcoming Worry Group was a novel adaptation of a cognitive behavioural therapy protocol targeting intolerance-of-uncertainty for generalised anxiety disorder, tailored for delivery to older adults in a group setting (n = 13).

The adapted protocol was found to be acceptable and feasible, and treatment outcomes observed were encouraging.

This proof-of-concept study provides evidence for an Overcoming Worry Group as an acceptable and feasible group treatment for older adults with generalised anxiety disorder.

It has been proposed that both positive and negative metacognitive beliefs sustain engagement in post-event processing (PEP). However, it is unknown: (1) whether individuals with social anxiety disorder (SAD) actually derive the benefits from PEP that they expect; (2) if this is not the case, how their positive beliefs are maintained; and (3) if they are aware of the counterproductive effects of PEP, why they still perform PEP.

To explore the phenomenology of the processes involved in PEP from the perspective of SADs, in order to address the research questions above.

Twenty-one participants suffering from SAD received individual semi-structured interviews. Transcripts were analysed using thematic analysis.

Analysis revealed three main themes: (1) ‘Only, safe and useful way to improve myself’: SADs feel the need to improve their social performance, and they believe that PEP is the only, safe, and private way to do so, which is an underlying motive for them to do PEP; (2) ‘It hurts more than helps me’: however, through PEP, they do not seem to obtain the benefit that they expect, or only find a variety of counterproductive outcomes; (3) ‘Better safe than sorry’: they sometimes find makeshift solutions to improve their social performance during PEP, which may maintain their PEP as a form of intermittent reinforcement. They weigh up such costs and benefits, and choose to perform PEP while feeling conflicted about PEP.

The results suggest that: (1) SADs rarely obtain the benefits from PEP that they expect; (2) their positive metacognitive beliefs are maintained by solutions they sometimes find during PEP; and (3) SADs choose to perform PEP while feeling conflicted; while PEP ironically maintains and exacerbates negative self-beliefs/images, it is the only safe and useful way to improve their social performance. These findings support and expand on the theories of PEP.